Mediastinal Fibrosis Mimicking Proximal Chronic Thromboembolic Disease

A 77-year-old woman was referred to our center for the workup of progressive exertional dyspnea. The patient had a medical history of systemic hypertension and diabetes mellitus. Three years before admission, she was diagnosed with pulmonary tuberculosis confirmed by positive culture of Mycobacterium tuberculosis on bronchial aspirate. She received a 6-month antituberculosis regimen, including isoniazid, rifampicin, pyrazinamide, and ethambutol. In the previous year, the patient reported progressive exertional dyspnea. After multiple evaluations, echocardiography suggested pulmonary hypertension with an estimated systolic pulmonary arterial pressure of 60 mm Hg. The ventilation perfusion lung scan (Figure 1) showed multiple nonmatched perfusion defects of the right upper lobe and multiple subsegmental defects and hypoperfusion of the left lung, suggestive of chronic thromboembolic pulmonary hypertension. The patient was referred to the French Referral Centre for Pulmonary Hypertension for hemodynamic evaluation and assessment for operability of chronic thromboembolic pulmonary hypertension by pulmonary endarterectomy. The patient was in New York Heart Association functional class III and had no history of syncope or hemoptysis. Physical examination found an overweight …